From the Outside In with Jane Coaston | Crooked Media
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November 08, 2022
America Dissected
From the Outside In with Jane Coaston

In This Episode

America Dissected comes to you LIVE from Boston at the American Public Health Association Annual Meeting. Abdul reflects on what brought him to public health. Then he sits down with Jane Coaston, host of the New York Times Podcast “The Argument” to talk about what public health gets right (and wrong) about racial justice, public communication, and politics.

 

TRANSCRIPT

 

[sponsor note] [music break]

 

Dr. Abdul El-Sayed, narrating:: This is it. Today is the last day to vote in the midterms. Refreshing Twitter, riding the poller coaster. They won’t change a thing when it comes to November 8th. Right now, there is one thing left to do and that’s persuading and mobilizing voters. In October, Vote Save America beat their goal, thanks to over 10,000 of you signing up to help get the vote out. If you haven’t signed up yet, it’s not too late. There are opportunities right up until the polls close on Tuesday. You don’t have to wake up on November 9th wishing you’d done more. Head to VoteSaveAmerica.com/volunteer now. [music break] This is America Dissected. I’m your host, Dr. Abdul El-Sayed. Last Sunday, we hosted our second annual live show from the 125th Annual American Public Health Association National Conference in Boston, Massachusetts. Here’s the show: 

 

Unspecified Announcer: Please welcome to the stage APHA Executive Director, Dr. Georges C. Benjamin. [music break]

 

Dr. Georges C. Benjamin: Well good evening, everyone, and welcome to America Dissected. You know, over the last three years, this amazing podcast and discussion has really challenged America and looked and listened and brought to um the forefront some of the most important issues of our day. Um. So we’re really pleased uh here at APHA to be able to host um this podcast discussion. Um. This is our second year in doing this, and I just uh told the hosts that we would love to do this um as often as uh, as the two of us can can do this. So without further ado, I’d like to bring to the stage our host and executive producer, Dr. Abdul El-Sayed. [music break]

 

Dr. Abdul El-Sayed: Thank you so much. So I just want to say thank you to Georges Benjamin, to Susan Poland, to the entire APHA team for inviting us back. 150 years, y’all. That’s a big deal. [applause] So I would ask who’s excited for an exhilarating conversation about public health? But you all have been here for a whole day already. But I’m going to ask anyway, who’s exciting for who’s excited for an exhilarating conversation about public health? Let me hear it. [cheers and applause] Also, who’s excited about the fact that we’re in Boston in November. And it’s like 70 degrees outside. [laughing] [applause] It has been quite the few years. Tough, tough few years for the country. For the world. For people who have done the work of fighting for the public’s health. So I want all of you to give all of you a round of applause, please. [applause] Now everybody here has a story about why they work in public health, why this was the work that called to them. And today I just want to share my story. I grew up just outside Detroit, Michigan. I’m the eldest son to a Egyptian immigrant who came to Detroit to study engineering in the 1970s. And my step mother, who raised me, who’s a daughter of the American Revolution from here in Michigan. St. Louis, Michigan. Now, if if the state and the city don’t match, it’s because it’s a tiny little city you never heard of. And um every summer. When I was in middle school, my parents would put me on a plane. And they’d send me off to Egypt usually before school ended because the tickets were a lot cheaper and I’d travel and I’d spend my time with my grandfather, my grandmother, aunts and uncles, cousins in the apartment where my father grew up. Now, my grandmother. Wisest, most intelligent person I have ever met, never stepped a foot in school for not even a day. Didn’t know how to read. She was the ninth of 14 who herself gave birth to eight kids, two died before the age of one. A personal infant mortality rate of 25%. And I’d hang out with my grandmother. And to bring me down to size, she’d point to one of my cousins and said, that one. I don’t have to tell you, is taller and better looking than you. Point to the other one, said that one’s smarter than you. Third one more athletic. Fourth one nicer, kindhearted. And at some point I have to say, like, what do I have going for me? Said you have the best thing of all. You have opportunity. And I appreciate what that meant. But the truth is, is that I grew up in a place where the air I breathed was clean was clean. The water I drank was pure. I got vaccinated just when I needed to. Protected me from all kinds of infectious diseases that took the lives of an aunt and uncle I never got to meet. I didn’t have the language for this at the time, but when I would travel those 15 hours, I travel ten years difference in life expectancy. But here’s the crazy thing. I didn’t have to go 15 hours. I could go 15 minutes south on I-75 into the city of Detroit, and travel the same ten year life expectancy gap. And as I got older, I came to appreciate the forces that created those differences, whether colonialism or racism, the ways that our travels take away life. We’re at it. And I had to ask moral questions about those profound differences. I thought that the way to take this on was to be a doctor [laugh] and also helped the fact that I’m a child of immigrants. And that’s kind of what your parents always tell you to do. And it wasn’t until middle, uh medical school where I came to appreciate just how profound our health care system fails the very people that I wanted to take care of. I was doing a sub internship in northern Manhattan and my job was to be the like worst doctor on the team. Right. But I was like, cosplaying a doctor. And one of the pieces of that job was to liaise with the emergency room. And I remember getting paged down to the emergency room one morning. It was January, late January. Snow had just fallen. And a woman had fallen and hit her head. And when I came to the ED, I could hear her yelling at the emergency room staff. Let me go home. Y’all don’t want me here anyway. So on my way to meet my patient, I asked the emergency room doctor. Well, what did the CT show? You fall, you hit your head. You get a CT. They said, well we didn’t do one. I said, why not? He said, well, she’d be a social admit. Which is code for someone whom our systems have ultimately failed and that we expect our medical system to fail too. I started to talk to her. To ask her story, to ask about her previous medical conditions. And when I came to realize that she wasn’t going to get the workup she needed, I talked to my attending and we agreed that we’d admit her. We ended up taking care of her for two weeks. We diagnosed her with full blown AIDS. That hadn’t been picked up on the history in the physical in the emergency room. Her diabetes was way out of control. One of the things I learned that HIV could do is infest the adrenal gland, the part of your body that controls your blood pressure. So despite the fact that she had been hypertensive for her whole life, she admitted to us hypotensive, paradoxically. She had an actively bleeding pelvic mass. None of this picked up in the emergency room. So we worked together on a discharge plan. We got her all worked up. We were ready to go. Two weeks later, we found her a place in the only rehab facility in New York City that took patients with HIV. And from there, we were able to get her access to housing to which she was entitled because of her HIV status. The day of discharge we’re going through the plan one more time. Ready to go, she said, you know, I don’t think I’m going to do that. I said, why not? She said, I think I’m going to go home with my daughter. I said, ma’am I didn’t know you had a daughter. She said, well you didn’t ask? I said I did. You didn’t tell me about her. What happened? And she said, well, I got in touch with her, and she wants me to come stay with her. I said, that’s great. But what happened the last time that you all were engaged. Why is it that it has been so long that you talked since you’ve talked to her and she said, well, I started drinking. I said, Well, you know, what makes you think that you’re not going to start drinking again? And she said, well, I haven’t had a drink in two weeks. Y’all fixed me. I said well, we’ve been medicating you. But this is something that you’re going to have to engage with. It’s a lifelong process, and this rehab facility can really help. And she said, you know, don’t tell me what to do. You’re not better than me. I said, You’re right. I’m not. So in the end, she ended up going home with her daughter. Two weeks later, I was putting the final touches on my residency application. I was getting ready to be an internal medicine doc. I said, you know what? I failed this patient, but I’m going to do my best with the patients that I have. It’s a great learning experience and I was going to have dinner with a friend at a Turkish restaurant. The only reason I remember that is because on the way I got onto the subway and I see someone laying on the seats and she turned her face. And it was my patient. So I decided I wasn’t going to be a clinician after all. Because here’s the thing. During my medical training. I realize that we have this profound interest in all of the things we could do in the clinics and hospitals in which we took care of folks. But there was a profound disinterest in the 99% of the time that people live outside of our clinics and our hospitals. And if we’re serious about addressing the challenges that people like my patient faced, it wasn’t going to be in the clinics and hospitals. It was going to be out in the communities. Our job in public health is about building the kind of world where people are never exposed to all of the social, physical circumstances that led my patient into that clinic that day. And building the kind of clinical world where no matter who you are, who your parents are, the color of your skin, how you pray, who you love, that you get access to the same medical care. And we are nowhere near that world. Today’s conference, we’re talking about leading the path to equity. My career ultimately led me to rebuilding a health department in the city of Detroit. The department had been shut down when the city went through bankruptcy and state takeover. And one of the most profound things that I learned in that work was about how far sometimes we get from the work that we say we want to do. And my hope today is to have a conversation looking from the outside in, to understand where sometimes we zig when we probably should zag. On that path to health equity. And to me, there are two questions that we need to really involve ourselves in. Number one. Why do we sometimes focus more on explaining the problem. Then we do on solving it. What is it about the approach that we take to public health? What is it about the way we understand our work that leaves us admiring that problem? The second one is this. If public health is about collective action for public good, if it’s about building the kind of environment where people like my patient are not exposed to the circumstance that led them to that day. Building a world where everyone has clean air, drinkable water, a good roof over their heads. They know where their next meal is coming from. They get to work a job that dignifies them and provides them a fair wage, where they’re not going to be exposed to things that can make them sick, either in the short term or the long term. If we’re serious about building that world, then why is it that we keep pointing the problem and not always fixing it? But the second part is this, what is the conversation that we have that may keep us from ultimately solving the problem. I want you to think about something, the word equity, in most of the world doesn’t actually mean equal access to the means of a thing. It means how much of a thing you own. Social determinants, talked about this earlier today. How often do you have a conversation with people in public health that ends where someone says, well, it’s just the social determinants and everybody kind of shakes their head and moves on. Before you got into public health, did you know what social determinants were? Did you know what a determinant was? So why do we use language that’s implicitly stigmatizing? Because it tells people that they don’t have access to the conversation that we’re sharing that’s so often is supposed to center them. So the hope today was to talk about those questions, and I could think about no one better than our guest today. So I’d like to introduce her. But first, I’d like to say a word from our incredible sponsors, the de Beaumont Foundation, who uh is generous, generously sponsoring sponsoring our podcast today. America Dissected is brought to you by the de Beaumont Foundation. For 25 years, the de Beaumont Foundation has worked to create practical solutions that improve the health of communities across the country. Foundation advances policy, builds partnerships, and strengthen systems to give everyone the opportunity to achieve their best possible health. Across the country, more communities are recognizing the ways that racism affects all of our health through a new project called Healing through Policy Creative Pathways to Racial Justice. de Beaumont and it’s partners have compiled policies and practices local leaders can use to promote racial healing and health equity, to learn more visit deBeaumont.org. And I’m not just saying that because it’s in the ad. Please do visit deBeaumont.org, because a lot of the conversation that we’re sharing today, uh they’ve done a lot of thinking about and make sure to stop by their booth. It’s number 209 uh downstairs in the exhibitor hall. So with that, I’d love to introduce our guest for for today. I came in contact with Jane Coaston through her podcast, which is called The Argument. Who here listens to the Argument? [applause] All right. So Jane is someone who’s had a career built on thinking about different areas of our work and adjudicating a conversation across them. So I really wanted Jane to come through and help us think about what we do from the outside in, because sometimes we get so used to our own conversation, so used to the way that we talk about things. We sometimes forget that we may not be talking to the people we think we’re talking to. Jane Coaston is the host of The Argument. Previously, she was senior politics reporter at Vox with a focus on conservatism and the GOP. Her work has appeared on MSNBC, CNN, NPR, and the National Review. The Washington Post, The Ringer, and ESPN Magazine, among others. In addition, she is a former resident fellow at the University of Chicago’s Institute of Politics. She attended Go Blue, the University of Michigan and lives in Washington, DC. Please give us a warm APHA welcome for Jane Coaston. [applause] [music break] Go blue. All right. So um this is how we greet each other from Michigan. [laughing] So, Jane, uh so uh you ever been to a public health conference before? 

 

Jane Coaston: I have not. I have been to uh the uh International World AIDS Foundation uh Conference, which is a fascinating event, because every year it’s like we’re going to end AIDS, somehow, which I think that that seems to me that taught me a lot of working um. I used to work at a pediatric AIDS foundation. I was a speechwriter, and that taught me a lot about public health um, because so much of it is about not the disease, but it’s about people. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: And about how people do things and why they do the things that they do. And specifically, the organization I was working at was focused on prevention of mother to child transmission of HIV, PMTCT, which even being able to say that in that certain way took me like six months. [laughter] And so much of this job, the job was about saying things in the right way and you didn’t say these words. And because people would get very mad at you and so much of it was really focused on getting people to do things that they wouldn’t ordinarily do or care about things that they wouldn’t ordinarily care about. And I think that’s what I came into the pandemic thinking about public hea– coming come from that perspective. When I thought about public health is my experience working on HIV AIDS and learning a lot about the fight against HIV AIDS and then coming into a global pandemic, I think I thought I knew a lot more than I actually did. 

 

Dr. Abdul El-Sayed: Mm. One of the things that I really appreciate about that example is that uh the disciplining around jargon. 

 

Jane Coaston: Yeah. 

 

Dr. Abdul El-Sayed: And I want to ask you right, because you host a podcast where you’re bringing people together across disparate perspectives on a number of different issues, sometimes the most contentious issues in American society. And I wanted to ask you, what is the role of shared language in disagreement in the first place? 

 

Jane Coaston: I think that in some ways, language plays both a, you can find commonality through language and you can also show disagreement just through the language that you’re using. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: And indicate ways in which you are, even if you’re not meaning to do this. I think that sometimes people show or attempt to show superiority of language through knowledge, through language. And so there are shows we do where we’re talking about, say, the Supreme Court and we’re referencing Supreme Court cases. And I’m thinking on the back of my head, like, the only reason I know any of this is because someone very kindly researched for it for me, and then I Googled it. Like, if you’re coming into this, you don’t know. Like, this is not a conversation. If you’re having a conversation about court packing, like step one, how many justices are on the Supreme Court right now? Step two, Like what would adding to that mean? What does any of this actually mean? And I think that so many times on our show, there have been ways in which language, especially because the language you’re using to talk about a person can so determine how that person receives the conversation. So for example, we did an episode about two years ago um about sex work, and we had a woman who um she was an adult film performer and she was in conversation with a woman who um she had survived sex trafficking. And there were a couple of moments during the show in which one of them would use terms that the other one was like, no, no, no, no, no. That’s not how I that’s not how I think about myself. That’s not what this is like um and I it was so interesting because it’s not that the terms were incorrect exactly. I mean, you know, there are a host of ways you could talk about this issue, but the ways in which these two people needed to come into this conversation, it was so important to use for for them to feel seen by language. Yeah. And I think about that with public health all the time, because there are so many times in which people see even the discussion of public health as being you trying to say that like, oh, I’m sick, like I’m dirty, like there’s a problem or something. I can’t be sick. I, you know, I do X, I do Y, I do Z. I’m not like those people who don’t do X or Y or Z. I’m different. I’m wearing a Whoop and a Fitbit right now. Like I’m different. 

 

[AD BREAK] 

 

Dr. Abdul El-Sayed: There is what you’re pointing to, is there there being an implicit stigma around how we choose to talk about an issue. And that showed up in a couple of different ways quite recently. One, in the words that we use to describe the Supreme Court’s abrogation of the right to X. Right. A lot of people will say you have to say the word abortion, because if you don’t say the word abortion, you’re implicitly stigmatizing abortion. And some folks will say and there’s a whole series of euphemisms that we use. You are they have taken away the right to reproductive justice or reproductive freedom. Right. They have forced pregnancy. And all of these carry a set of frames that load a whole set of values and a whole attempt to push the conversation. And what’s what you heard that earlier in the first iteration of this was pro-choice versus pro-life. Both of these things are hard to be against. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: Right. Nobody walks out who’s like I’m against life. Right. Or I am against choice. It’s that we want we want to frame the conversation almost to pack it so that one has to choose to be against the thing. One of the interesting aspects of public health discussion is that we want to have our cake and eat it too when it comes to science. So, for example, if you were to to to uh refer outside of the context of the public health community to gay and bisexual men as men who have sex with men, I think it would be very stigmatizing. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: And yet public health has tried to be as as inclusive and specific about exactly what they want to talk about. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: And so we end up talking about men who have sex with men. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: And so I guess my question to you is the degree to which we frame and what we frame. How much of that should be led by who we’re serving and how much of that should led be led by what we think we’re describing? 

 

Jane Coaston: It has to be led by who you’re serving. Even if the people who you think you’re serving don’t think you are serving them. I think a lot about the men who have sex with men, example, because the the number of times in which you have conversations with folks when you’re working on HIV AIDS, I’m sure a lot of you know in which someone is like, oh, don’t you mean gay men? And I’m like, yes and people who would never in their wildest imaginations ever refer to themselves in that way. Folks who are living in in context in which being gay is that you can get the death penalty where they live for being gay or where they just don’t think of themselves in that way. But they are still men who are having sex with cis or trans men. And so I think that you have to let the community that you’re trying to serve lead the way in the information that they need. For instance, you were talking earlier about how the person that you were serving, the person you were trying to reach, she felt as if, no, no one had tried this so she just wasn’t giving you information. And the number of times in which I think during the pandemic you were hearing from people who were being told to do something, but they weren’t being it wasn’t being explained why they needed to do it. And they also weren’t being given the chance to ask questions. And I think that something that I think a lot about is how often how powerful the words I don’t know are. I know that I’m always very upfront, which there’s a whole host of things. I don’t know a lot about um math, for example, which is why some of you have been to medical school and I think you’re all amazing and awesome and um that’s– 

 

Dr. Abdul El-Sayed: Don’t know much about math either though. [laughing]

 

Jane Coaston: I just assumed that there’s some math portion of this. But maybe that’s a secret thing that they do. They don’t, you don’t want to talk about it. It’s okay. Um.

 

Dr. Abdul El-Sayed: I don’t know Jane. [laughing]

 

Jane Coaston: But I think that the power of saying I don’t know. I think that there were lot– you know, there were parts during kind of the early days of the pandemic where there was a lot of information that we didn’t have. And I think that there were some people who were like, no, we have to perform knowledge. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: Not that we need to know. But we need to perform that we know or else people won’t listen to us. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: Which I totally understand. I but I also think that there is a point where you’re like, look, here’s what we know right now. We are probably going to learn a lot more as time goes on, but we don’t know that right now. And I think that that the way that people would respond to that is sort of in the way when you say, I don’t know, in general, people don’t get as mad at you. When you say, I don’t know, as you might think they do. Like, it turns out that this isn’t third grade. And that saying I don’t know does not mean that your third grade teacher yells at you. People are just like, oh okay.

 

Dr. Abdul El-Sayed: Yeah. So this is, you’re you’re you’re uh getting to a really um sensitive point for a lot of us around the question of masks early in the pandemic. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: And this shall be studied in public health schools uh until kingdom come. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: But one of the arguments that folks had made so, you know, my my understanding of the situation. Uh. Of course, remembering early on how we were talking about it, was that what we thought we knew was based on Sars-Cov-1, the closest cousin. And Sars-Cov-1 was not transmissible before symptoms. So the idea was we don’t think that anyone is going to be transmitting before they have symptoms. Ergo, we have to keep masks for the people with symptoms. There’s a big policy issue underlying that but we’ll– 

 

Jane Coaston: Right yeah. 

 

Dr. Abdul El-Sayed: –You know. Well, we’ll step over that for a second. We’ll get back there. And the argument was, based on what we think we know, do not wear masks because we need masks for other people. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: And then we found out that we were catastrophically wrong. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: Right. Which did two things. A, there was a whole bunch of transmission we could have prevented. And, B, it it undercut the authority of public health from the jump. And the thing I really appreciate about what you just shared is that we tried to infer in a situation where we did not know. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: And the hard part is this. In public health definitively there are always going to be people who will leverage the vacuum of knowledge to sell a con. And the question becomes, how do you engage with the fact that the I don’t know will be used by someone who says I know loudly to say incorrect things? How would you engage that as a as a communicator? 

 

Jane Coaston: I actually think that that is a opportunity rather than a fear. I think that saying that you don’t know and not performing to be definitive, I think in some ways to me that sounds more trustworthy. There are one of the, I done a lot of work on conspiracy theories, but then I also I’ve, you know, conspiracy theories inherently lead you to learning a lot about grifters and scammers. 

 

Dr. Abdul El-Sayed: Yeah. 

 

Jane Coaston: Um. I don’t know why that might be. But there is some degree to which grifters and scammers perform a type of confidence that some people find appealing. But also sometimes they do this thing of being like everything else is a grift and scam besides me. And I think that the way in which you perform and let’s keep in mind that so much of public health, so much of public policy, it’s not just about doing the thing. It should be more about doing the thing, but it’s also performing doing the thing. It’s the same reason why politicians have to go and like there’s, you know, when you when you run for president, you shouldn’t run for president. But there is like this uh restaurant in the Bronx that you go to. And every like every presidential cycle, there are these group of like Republicans who go to this restaurant in the Bronx and everyone’s mad. No one wants to be there, but you have to go. It’s sort of like, you know, you got to go to Manchester, New Hampshire, and eat at this restaurant where they they sell mozzarella sticks. It’s a whole thing, but it’s a performance. It’s a performance of doing the thing. And I think that in public health, when you say, I don’t know, and I’m trying to get more information, I think about the way that I would respond to that if my doctor said that. Or I think for many people, if my parent’s doctor said that, if my mom went to their doctor and went to her doctor and there was a problem, and her doctor looked at her and said, I don’t have all the information right now. I’m not sure what’s going on here, but I’m going to focus on finding out what’s going on. I can feel I know that I would feel better. Not like relieved solution better, but I would feel better because I would feel like we were in this together. We were on a path of finding information. If my mom’s doctor said, I have all the answers and I know everything already, and then they turned out to be wrong, I would be really mad. 

 

Dr. Abdul El-Sayed: Yeah. 

 

Jane Coaston: And I think that giving that room, saying that we’re in this with you, we are we are not just arbiters. We are not above you. We are in this journey with you trying to figure out what to do. We’re wiping down our groceries. We’re, you know, buying all the Clorox wipes you can ever buy. Remember that? Do you remember when just like Clorox wipes just all over the place and like we were all in it together. And if I think that if public health authorities, especially when you get the sense that people who are working in public health are also people who go home to a kid who somebody tested positive at their at their preschool. So now they’re home for two weeks and you don’t know what you’re going to do. Like feeling like you’re in it with whether it’s your doctor or whether it’s with public health officials. I feel like that to me is an opportunity. And yeah, I’m sure someone’s going to come in and say like, have you tried copper bracelets or something? But like– 

 

Dr. Abdul El-Sayed: Or hydroxychloroquine. 

 

Jane Coaston: Yeah, exactly. [laughter] But like, I think that when you come in and say like, you know, well, we’ve tested that and it turns out it absolutely doesn’t work and it turns out like these different things. And here’s what we do know right now, but we’re always trying to find out more. Ask me questions. And if I don’t know the answers, I’m going to go work really hard to find out what those answers are. 

 

Dr. Abdul El-Sayed: I really appreciate that point. There are two points I want to um I want to sort of press on. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: The first is on the trust on institutions generally. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: I think part of the challenge is that institutional trust, we know, is at an all time low. And implicit in the example that you raised about uh about your mother’s doctor is that it’s your mother’s doctor. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: And I wonder how much grace a lot of the folks who have end up ended up getting conned, right by all the cons around uh vaccine safety and efficacy uh around the pandemic being real in the first place, around masks, how much grace they might extend to us saying no, because I think that’s the fear. I think the fear is we got one shot as institutional capital P, capital H public health TM. Right. And if we if we don’t tell them something, we have lost them forever. The problem is, is that if you tell them the wrong thing, you have lost them forever. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: I want to ask you um, in a world where institutional trust is at an all time low and we speak on behalf of institutions that most people don’t hear from in the first place. 

 

Jane Coaston: Mm hm. 

 

Dr. Abdul El-Sayed: Because so much of our work is invisible. How should we be thinking about our engagement around rebuilding institutional trust once it’s lost? 

 

Jane Coaston: Well, I actually think that people have more experience with public health than they think they do. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: And I would say that have you been to a restaurant in the last like ten years? 

 

Dr. Abdul El-Sayed: I have. 

 

Jane Coaston: Did you notice that there was a sign in the bathroom that told you to wash your hands? And in general, people are not like, whoa, whoa, whoa, whoa, whoa. Here is big public health telling me to wash my hands [exhale of breath] like people are good with that. Like good news. It seems like ever since John Snow broke that pump, I think we kind of are good on that. 

 

Dr. Abdul El-Sayed: Can we get a round of applause for John Snow reference here? [laughing] [applause] 

 

Jane Coaston: Look. I hate cholera. Big cholera bad. Very bad. Um. But I think, like, it it turns out people have a lot of individual experience with public health in a lot of different ways, whether that is just the fact that they washed their hands before they eat and after they eat. And when they use the restroom, which is like that advancement alone, I think about this sometimes. If you think about like the royals of the 16th and 17th century, like a third of them all died based on we don’t wash our hands and some of us never bathe at all. But like you you have contact with public health in ways great and small. And so I think that the idea that it’s one shot. No, it’s it’s a bunch of different shots. The problem is that each of those shots has to be taken so seriously, because I think that especially when you have something like COVID, you have a disease that we don’t know that much about, but we like. We knew that it was going it was looking to be one type of illness. And not it wasn’t Ebola. It wasn’t something that I think people immediately recognized as something they needed to be like that was immediately deadly and terrible. It was deadly and terrible and a very different kind of way. And so I think that the problem and the opportunity is that you have a lot of bites of the apple. It’s just that each of those bites has to be a good one. 

 

Dr. Abdul El-Sayed: Yeah. 

 

Jane Coaston: Each of those has to be that when you are working with anyone in a medical capacity, you need to be respectful. Otherwise, you wind up with people who were like, well, my you know, my doctor told me that this wasn’t a problem and it turned out to be. So, no, I’m not getting a vaccine. All of those decisions lead up to the big decisions. They lead up to will or I won’t I get vaccinated. Will I or won’t I take the pandemic seriously? And if your exper– you know, I think that for most of us in this room, even those of us who don’t work in public health, I have had pretty good experiences with the medical profession, knock on wood. Like in, you know, I was born, worked out great. Um. My childhood doctor, very nice person, um went to the doctor sometimes in college. That worked out great. Um, ran into a wall once and got stitches. I was playing tag. It’s a long story, but, like, my experiences have been pretty good. And I think though, and that led to me having trust in the process. 

 

Dr. Abdul El-Sayed: Yeah. 

 

Jane Coaston: And a trust and grace for public health officials. But if you didn’t have that, if you felt each interaction that you had, each of those bites of the apple was stigmatizing in which people kind of, you had children and when you brought your kids into the doctor, you felt like your doctor kind of was implying that you shouldn’t have had kids, which I know, you know, I grew up in an area that was pretty like working class. And I remember I had a neighbor who, you know, she had her kids really young. And she when she was doing a like a maternal health thing, basically the implication was that the doctor was like, why are you breeding? 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: And you’ll be stunned to know that I don’t think she really has been to the doctor very much since that. And so I think that you have a lot of bites at the apple. And I think that the ways in which people you know you can you have efficacy as public health officials even just in little things like the fact that people wash their hands, they cover their mouth when they sneeze, little things that you’re like. It turns out that that makes a huge difference. It’s just that each of those bites of the apple has to matter. 

 

Dr. Abdul El-Sayed: I really appreciate that point. And um the hard part is if you look at folks who have gotten vaccinated and haven’t. One of the single biggest predictors beyond ideology is whether or not they were insured or have been uninsured. And so you end up in a situation where nobody’s ever given them health care for free. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: And now we’re trying to offer it. And then the other aspect of this is that, you know, we don’t appreciate in public health how the world sees us in the sense that, you know, you brought up your experiences with doctors and a lot of the folks in the audience would say, no, no, no, public health is not the doctor. That’s the health care system. But the fact is, is that most folks see public health as an extension of the health care system. 

 

Jane Coaston: It’s the health word. 

 

Dr. Abdul El-Sayed: It’s the health– 

 

Jane Coaston: It really throws you off. 

 

Dr. Abdul El-Sayed: And and that’s the thing is that most people don’t see public health operating. They don’t see that sign that says employees must wash their hands. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: And say, ah, that public health department working for me. Right. They see that and be like, hey, you better wash your hands. That’s disgusting. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: And–

 

Jane Coaston: Or you see, like, restaurants with, like the A or B or C grade, and you’re like, how did you get a C? 

 

Dr. Abdul El-Sayed: Yeah. Exactly. Nobody’s ever like the public health department did that, thank you for letting me know what’s going on in that kitchen. It’s nasty. 

 

Jane Coaston: Yeah. 

 

Dr. Abdul El-Sayed: I, I. And I think it’s important for us to appreciate that story. The there are two pieces here that I want to pull on. One is so much of what we do, we we value the science of. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: The thing about science is that it’s not a body of knowledge. It is a system of understanding the world. And we don’t do a good job of telling the story. And the worst part of that is that when we talk about the outcomes of science, we assume that people are reading the studies that this is based on in the context of the scientific process, and that’s how we present that. And I guess I’m wondering in the way that public, like you’ve been communicated to as a professional communicator from public health, what are we getting wrong about storytelling and what should we be doing better? 

 

Jane Coaston: Well, [sigh] the first thing I would push back on. Please don’t tell me a story. Just tell me what the what the information is. A story implies that there is a beginning, a middle, and end. That there is some sort, that there are characters. There’s a protagonist. There’s an antagonist. The antagonist, I assume, is the disease. Like, oh, no, it’s diphtheria. Um. But the storytelling also implies that you are in charge of the narrative, that you know what the story is. Thus you are telling it to me. But as we’ve learned, we don’t really know what the story is. I think as someone who I found in my work, one, I don’t like being sold things and whether that’s being literally sold something or whether that’s when someone comes onto the show, onto my podcast and I’ve seen how they talk about their particular issue to other people, and then I know that they’re talking about it to me in a very specific way. Generally, this is in a way that makes reference or alludes to the fact that I am Black and a woman. And so there’ll be people talking to me in this very specific way about like what we’re really trying to do is stand up for working class people of color. And I was like, I’ve I’ve seen you on Tucker Carlson. And that’s not what you said then. 

 

Dr. Abdul El-Sayed: Hmm. 

 

Jane Coaston: So when the challenge of storytelling, one is that you sound it makes it sound like you’re in charge of the story or that you already knew what was going to happen when you don’t. And also, I think that for many people, it sounds like you’re trying to sell them on something, which I know that in some ways you sort of are you are trying to sell them on the idea of getting vaccinated or washing their hands or doing good things for public health. And I think that to me, if you make if you make the information, one clear and talk about like we didn’t you know, it’s funny now we sometimes we read um how people like, oh, you know, people used to think this and weren’t they backwards? And yeah, they were. But that’s the information they had at the time. And that’s also what authorities at the time were telling them. They didn’t come up with that out of the clear blue sky. They had, you know, the medical writers of the day saying things like, if you bathe too much, your your skin will be vulnerable and you’ll get sick more often. And I think that that’s to me, the the most important part is let people know as much as you can in the simplest ways that you can, and let them know that you’re still part of this learning process, too. Don’t give them a story, because then when the story changes, when it turns out that masks are a good idea. Or it turns out that the disease isn’t spread the way you thought it was, then it sounds like you’re just doing that. You know, you’re doing kind of a Star Wars thing where you’re now editing things in. To be like oh actually Midichlorians were part of it the whole time and like no, no. 

 

Dr. Abdul El-Sayed: So– 

 

Jane Coaston: Wait they weren’t. 

 

Dr. Abdul El-Sayed: I’m going to I’m going to push you on this, because–

 

Jane Coaston: Okay. 

 

Dr. Abdul El-Sayed: I think there’s a way where we use statistics as in I mean, this is how we understand the world of statistics. And we might say something like the probability of COVID infection among unvaccinated people in this particular cohort was 80%, and the probability of COVID infection among vaccinated people was 30%. Clearly, the COVID vaccine prevents COVID infection, and that is a true interpretation of that study. The problem, though, is that somebody will say, well, 20% of the people who were not vaccinated didn’t get the disease. And 50% of the people who were vaccinated did versus saying, hey, look, we’re in the situation right now where we have a choice, right? We have a choice between taking this vaccine that we’ve studied and come to understand will prevent 30% of cases versus not. Now the choice is yours. But I’ll tell you what I’m doing for me and my family. I’m getting vaccinated and my family is getting vaccinated, and it’s because I want to do the best I possibly can. Or how does the vaccine work? Right. Isn’t my immunity strong enough? It’s like, well, have you ever heard watch one of those cop dramas and uh they do a be on the lookout call, all this is a be on the lookout call for your immune system. So when it sees COVID, it knows it, and it can it can attack it. And I guess the point that I’m making is that sometimes we think that full on, uncontectualized information is the way to communicate. And I worry that sometimes when we don’t tell the story of, like you said, here’s what we’re doing. We’re on this journey together. Right. Journey implies a story. And the last thing I said, all best, all the best stories don’t have endings. They just we find ourselves in the middle and it could end a different way. So I’d love to hear what you think about that. 

 

Jane Coaston: Well, I think, one, I like stories with endings. Big fan, huge fan of stories that just are like and that’s it. And we’re done now. Um. You can go uh. 

 

Dr. Abdul El-Sayed: But I was never satisfied with Lived happily ever after. It’s like nothing happened tomorrow? Like there was definitely something that happened tomorrow. 

 

Jane Coaston: Bedtime at your house must have been [sigh]. 

 

Dr. Abdul El-Sayed: Oh, it’s wild. [laughing]. 

 

Jane Coaston: Exhausting. No, I think that what I want is I want contextualized information. I want information that makes sense so that you can say, for instance, um one of my favorite things are kind of those Instagram ads that um oh that studies show that blah, blah, blah, blah, blah. And the study is like the end equals nine people and it’s at, yo, the study was among like the nine person people this Instagram influencer knew, um because I think that the problem you have is that the language of studies and statistics has been regrettably taken away from you. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: By nonsense merchants. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: And I think what’s important to say is, like, here’s, you know, the context of this is that this is a study of 40,000 people or this is a study that was done under these conditions. Here’s everything that we know. But I would still say, like still make it clear that like we’re always learning something. But I know that this is enough information for me to do this. And especially because I think that um one of the interesting things that I found is that in general, the people who are extremely anti-vax, it is not it’s not a I’m anti-vax. It’s anti-vax and I’m very pro this other crazy thing, this other completely different thing. And I believe in it wholeheartedly. So I think that that shows me that those people are they are not receptive to your message, but for some reas– but they are receptive to messages writ large. They aren’t a close– you know, they’re not just closed. They’re open just not to you. And I think that that to me is an opportunity to show grace and humility, to talk about how, yes, this is very confusing. And I understand why you are a little reticent to listen to pharmaceutical companies, especially I think that um one piece of this I keep thinking coming back to is that you have people who are living in context in which pharmaceutical companies, they know what their names are because of the opioid crisis. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: And when you are coming from an environment in which the opioid crisis has ravaged your community, and then it’s like and then a pharmaceutical companies going to come in and save the day? Like, I understand why people would be like, hang on a second. 

 

Dr. Abdul El-Sayed: Yeah. 

 

Jane Coaston: So I think coming into that context is so essential. I am not saying just sign everyone up for JAMA and just be like it’s in there. But I do think that oft– 

 

Dr. Abdul El-Sayed: Read the, read the appendix. Appendix three. 

 

Jane Coaston: I know. And I do think that offering people as much information as possible, giving them the context and telling them, like, you are in this, too. It’s not like you are secretly not taking the vaccine and getting other people to do it. You’re in this, too. You you are a part of this. And if that’s storytelling, then okay. But I just think that sometimes I’ve noticed in public health context, in the same way with policy contexts, there’s this thing people do where it’s like, How do we sell this to our audience? And I think and I always think, well, don’t use the word sell. 

 

Dr. Abdul El-Sayed: Yeah, that’s a really important point. And I’ll say that one of the frustrations that I often have in the conversations I have about the vaccine with folks who are reticent to get it, is that when I ask them, why not? Right. You listen for the emotions and almost everybody has an anecdotal story to share. 

 

Jane Coaston: Oh, of course they do. 

 

Dr. Abdul El-Sayed: And so the point that I’m making is that implicitly storytelling is convincing because somebody will say, well, let me tell you about my cousin. Got the vaccine, and guess what, three days later got bit by a dog. I’m like, what? How is that connected? Right. He’s like, well, he was running more slowly. Dog wouldn’t have caught him. And you’re like, clearly, you cannot believe that. Like, well, I’m just saying. Right. And so–

 

Jane Coaston: It’s always I’m just saying. 

 

Dr. Abdul El-Sayed: I’m just asking questions. [laughter] So I feel like if the response is usually framed in a story that stuck. We got to be smart about taking the data that we create and being able to offer right, something to say well, let me tell you, let me give you something else that you can hold on to. Um. I want to move– 

 

Jane Coaston: I would I would also say just very quickly, though, that like with that example, a lot of times it’s because the people you know, I happen to know people very closely who are doctors. I happen to know people very closely who are public health officials. I have a very good friend who works for DC Health and has worked very hard on both the pandemic response and on preventing sexually transmitted infections throughout D.C., which that’s why she’s a hero. But I think that for a lot of people, they know their cousin and they don’t know you. So who are you and how can you become known to them in their lives? 

 

Dr. Abdul El-Sayed: Yeah, that’s a really good point. Um, I really appreciated you touched on a couple of really important points that we sometimes forget. We tend to create silos between different things in our mind. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: This is health care. This is public health. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: That is the Pfizer vaccine. This is Pfizer and whatever opioid that they created. Or you name the pharmaceutical company. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: And people’s understanding is not siloed based on this the the objective siloing that we do in our minds as experts. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: And I think being able to put ourselves in the shoes of someone who is approaching the world outside of that perspective is fundamentally critical. And I really appreciate that insight. I want to um talk about the the one of the main subjects of of today in the conference is the question of equity and racial justice. And so much of the way that we’ve engaged this question has to do with identifying disparities. And then sometimes we are less specific about how we want to think about tackling them. But the other thing about identifying disparities is something you brought up earlier, which is to say that when you identify systematically one group of people as experiencing disease more often, the way they process that is to attribute that to a bunch of other behaviors that are themselves stigmatized. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: And the argument is, well, I don’t do those things, and therefore, I am not. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: And I wanted to ask you, how are we missing the boat as a community? I think everybody you talk to in this room will tell you we are 100% fundamentally committed to addressing the inequities that we see. But I think the way we have the conversation tends to miss that boat in a number of ways, whether it’s failing to identify what we want to solve or it’s in using language that is implicitly stigmatizing from the perspective of somebody about whom they find themselves the object. How should we be thinking about this? How should we be talking about it in a way that’s effective and actually points to solutions and does not stigmatize the people that we’re trying to center? 

 

Jane Coaston: I mean, I think that any response would need to be contextual. Um. I think that for a lot of folks who are more, you know, who are dealing with the brunt of whether it’s this pandemic or whether it’s chronic illness writ large, them being sick is like the last domino that fell where the first domino was ways back. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: Whether that was growing up in a situation that left them more vulnerable, whether that was growing up in a situation that left them with nutritional deficiencies, whether that was growing up in an environment of constant and chronic violence and the anxiety that that creates. I think that sometimes public health needs to be just as contextual as the people it’s trying to reach. So when we’re talking about issues that are impacting, for instance, African-Americans in America, we need to also be talking about issues that are impacting working class people and poor people writ large. And I think because I think that so often when you hear that like, oh, this is like I was saying earlier that, you know, I’m not like that I this isn’t my problem. But you think about the problems that you do have and you think about the ways in which you are vulnerable. And I think that the response needs to be taking all of those vulnerabilities into account. I think too often we talk about we talk about race and we don’t talk about class enough when it comes to a public health context. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: Which I think too often means that we’re missing the boat on what really can be what could be truly impactful for so many communities. And I think about this when we’re talking about, for instance, um the ways in which African-Americans in America experience public health. It’s not all going to be the same. 

 

Dr. Abdul El-Sayed: Right. 

 

Jane Coaston: I have a different experience of public health than some of the people I grew up with. And Serena Williams has a different experience of public health. Um. Even with facing maternal mortality issues that she did. And I think that too often we want to talk about race and then we want to say that where if we’re using the right language, we’re doing a good job. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: If we are refer– using the right references. We’re doing a good job. And I’m like no, you are taking it’s like you’re taking like the easiest possible road because all you have to do is change which words you were using. If it were that easy, we would have fixed it already. 

 

Dr. Abdul El-Sayed: Mmm. 

 

Jane Coaston: I think that the issues impact of poverty, which first and foremost are you know, we you talked about this earlier, they dramatically alter the life expectancy of individuals and communities. But also, it means that by the time you want people to make public health decisions like vaccinations, you you talked about this already. In fact, our entire conversation has been touching on the issues of poverty where folks don’t have insurance. So why would you give them a vaccine for free? 

 

Dr. Abdul El-Sayed: Right. 

 

Jane Coaston: Folks, their experience of health care, of any sort of health is either at free clinics or in some communities in rural America, massive free clinics that people drive to for hours that offer perhaps the first dental care they’ve ever had. People’s experience of public health, often especially in poor rural communities, is so sparse that the vaccination drives would seem kind of weird. It would be just sort of like if you just showed up one day and you’re just like, hey, we’re going to give you a drug. Why? Well, because you need to have it. I think that the conversations that we need to be having more of are about poverty and about how, you know it, language is important. People want to be seen in how they’re talked to and talked about, especially when you think about how inherently so many issues come down to respect and disrespect. I think about that a lot in our politics, where so much of our politics seems to come down to an idea of who is respected and who is disrespected. But when we’re thinking about public health outreach, it also needs to be conversations about poverty to get at the fact that by the time you have gotten to a in public health intervention, a bunch of other things have happened that that are going to make that intervention even more difficult. 

 

Dr. Abdul El-Sayed: Right. [music break]. 

 

[AD BREAK]

 

Dr. Abdul El-Sayed: I uh want to note that if you have a question uh for Jane or I, um if you want to make your way to the mics, uh that that’d be great. And then I just want to finish with a final point. You raised this in our politics. And one of the challenges that we found is that public health has been supremely politicized in the context of the pandemic. 

 

Jane Coaston: Mm hmm. 

 

Dr. Abdul El-Sayed: But that point that you made about respect is a really important one, which is to say, sometimes when we engage, we do not appreciate the degree to which our non-engagement in the past is itself a statement. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: And–

 

Jane Coaston: Why are you here now? And you weren’t there then?

 

Dr. Abdul El-Sayed: You want to tell me something now but it doesn’t seem like when I needed your help, you were there for me. 

 

Jane Coaston: Right. 

 

Dr. Abdul El-Sayed: So why should I listen to you now? And I think the the the question that we’ve a lot many of us have been asking, because it’s so fundamental and, you know, we have a big election on Tuesday, is what happens when people capitalize on the politicization of public health to undo our capacity to get it right next time. What happens then? And I guess my question uh to you, as someone who’s thought a lot about the political debate is how do we get political? Because if not everybody has access to a long, healthy life, then a long, healthy life is a resource that not everybody gets. And politics is about resources. How do we get politiciz– political without being partisan? 

 

Jane Coaston: I mean, I think that you that politics the goal of politics is not politics itself, that it’s not supposed to just be about elections. It’s supposed to be what are you actually doing for people? 

 

Dr. Abdul El-Sayed: Right. 

 

Jane Coaston: How are people accessing something? What what are you know, you have an actual goal. You have an actual destination you’re going to. Politics is the road because, you know, we don’t do I don’t know medieval wars. 

 

Dr. Abdul El-Sayed: Yeah no. 

 

Jane Coaston: We do politics instead which you know–

 

Dr. Abdul El-Sayed: God help us. 

 

Jane Coaston: –similar. But I think that remembering what that endpoint is, if you want to get engaged in pol- in politics, you’re not doing it because you think that that you because of an election, you’re doing it because you think that a particular ballot issue or a particular Election Day decision will influence public health. 

 

Dr. Abdul El-Sayed: Right. 

 

Jane Coaston: And I think that sticking to those values and making it clear that you will work with anyone who says who says and puts money behind this particular public health standard, who says this particular issue matters enough, and you’ll say like, that’s great. And I think that that’s where it’s really important to think about what, you know, what are your actual goals and destinations? What do you want to do? Do you want to um lessen COVID transmission? Do you want to reduce the rates of HIV infections? Do you want to get more people access to X and Y and Z? Politics is the road you’re going to take to do that, but you need to know what your destination is. And because occasionally some people will, it’ll become very, very important that someone wins an election. But you don’t really remember why. Politics is just the road. Your destination is what are you actually trying to do? 

 

Dr. Abdul El-Sayed: All right. I want to take a couple of questions from the audience. Um. Let’s go there first. 

 

Audience Member 1: Hi, Jane. I’m a huge fan. I listen to the Argument all the time, so I’m going to argue with you because–

 

Jane Coaston: Okay, great. 

 

Audience Member 1: Why wouldn’t I? Um. I appreciated you invoking the story of Serena Williams in your response to like, are we talking about racial equity specifically appropriately? 

 

Jane Coaston: Mm hmm. 

 

Audience Member 1: And one of the things we know in public health is that race and poverty, race and class do intersect, but it’s race that causes the outcomes, particularly for African-Americans. So Serena Williams is the poster child for this. A woman with every resource at her disposal almost died because her doctors did not believe that she was experiencing this um uh blood clot that could have cost her her life. And so I just want to push back on you and ask, you know, this this piece about talking about um I think you said collective vulnerabilities when it comes to race for African-Americans. You know, I listen to you. You know that there is cumulative disadvantage because of race, because of all of the policies and implications that have happened over years anyway. I’m getting to the point to basically say you’re kind of like saying that poverty is the thing that we should be talking about as a unifying force. But for some of us, it’s not poverty. It is race that is causing the outcomes that we see that persist generation after generation. So can you like unpack that a little bit? 

 

Jane Coaston: Absolutely. And I really appreciate that question because I mentioned Serena Williams and I thought about what happened to her and I was like, oh, that’s an interesting point. I think the point that I want to make is that the challenge I see sometimes when people talk about, you know, how we were apparently are going to keep having a conversation about race and it’s like, it’s time to have the conversation about race. And then we’ve never had the conversation about race, and I assume we’re going to get to it someday. Um. We should put that on the schedule. Maybe get a zoom. But I think that too often when we talk about race, it becomes a talk about how to perform language more effectively or how to perform how we want to engage with whether that’s Black health care workers or Black people receiving health care. I think that when we’re talking about poverty and obviously those two are intertwined, I think that poverty, the implication there is that the only thing that you can do about poverty is to make people not poor or less poor. And I think that for me, my I really want to, one I want to entangle race and class. I think that those are inherently tangled. I think that it’s pretty clear that when in the news media, when you hear working class voters, you immediately know you’re not talking about my dad. When you hear like people talk about Black voters and Christian voters and it’s like as if Black people are not Christians, which is huge news to a large swath of this country. And so what I would say, though, is that when we’re talking about race, sometimes we are talking about African-Americans as if they all African-Americans are living in poverty. 

 

Audience Member 1: Right. 

 

Jane Coaston: And we are not taking the fact that someone who is African-American, it turns out that if you know, if you are Serena Williams, you will still experience um, you know, risk maternal mortality outcomes. And that it turns out that when you even if you control for income, maternal mortality outcomes don’t change for Black women. And I think that so often when we talk about race or we say we’re going to talk about race, we permit it to be far too easy. We permit it to be about saying the right words or even talking about using words like equity and racial justice. But words are easy and action is hard. And I want to encourage people in general to make harder decisions. I’m aware that that is not going to be like fun. But I think that when we talk when we’re talking about the interweaving of race and class, I think that that conversation needs to be just as difficult as the solutions will be. 

 

Dr. Abdul El-Sayed: Thank you. Here. 

 

Audience Member 2: Yes, thank you. So as a public health person. Right, I’m trying to connect the different dots. And you spoke about the feel or the lack of trust in the institutions and the public health institution and all the different parts that it touches. And then there’s this, you know, the cousin that has the vaccine and then gets bit by the dog. And that’s the story. You could say that is being told within a micro community or a family. Um. And you know what? What do you do to address fear when the trust is already lost within the public health system? And someone you know, my mother is going to listen to the auntie, more than other family members or community members or accessible individuals that have training in you know, public health, medicine, or um working on navigating the system. So I’ve I’ve heard about trust. I’ve heard about the siloed institutions. But I’m interested to hear more about addressing fear in a community that has already undergone trauma. 

 

Jane Coaston: Um. So I think fear is a really important piece here because I have a lot of illogical fears. Um.  I am working through a fear of flying that for a while was deeply crippling. And no matter how many times people explain to me that planes are incredibly safe and that you have a better you have a better, a better chance of being bitten by a cow than you do of dying in a plane crash. It turns out fear didn’t care. Fear was not logical. And so I think that something that we need to do is to take fear seriously, take fear as seriously as I would want my fears to be taken seriously. The most irritati– if any of you have dealt with like a phobia or fear or anything, the most irritating thing in the entire world is when people don’t take that seriously. When people are like, Ooh, you’re afraid of flying. Like you know just deal with it like, no, no. And then you don’t want to be on a plane with me while I’m just dealing with it. And I think I think that the to me, it’s really important to say, like, it is scary. I understand there are people who are afraid of needles, for example. And that’s a major that’s a major issue for anyone receiving a vaccination. There are people who are afraid of the possible outcomes, especially because there are so many, it seems to them, so many possible outcomes. And so they go to a trusted source who is willing to kind of back up their fears, the auntie or the relative or the person who posted on Instagram that recipe you like, who also is a big time vaccine denier because they all are. It’s always like you you’re a vegan and a vaccine denier? What are the odds um on Instagram. On Instagram, to be clear. But I think that taking that fear seriously, making it clear, again, you’re in this with them, giving them as much information as possible and also like so I think sometimes it would be helpful um to even just kind of talk through what those fears are, where those fears came from. Because I think that I there’s been a lot of research showing that fact checking doesn’t really work. Like, it turns out people can get more locked into what they think. But what can work, I think, is that many times those fears aren’t logical, but they are very, very real. And taking them seriously, I think would be effective. 

 

Dr. Abdul El-Sayed: I just want to add to that to that note. Um. The question of of presence and purpose are going to come to a head in a moment of crisis. And so if I haven’t heard from you or heard of you or heard about you, and more importantly, you haven’t heard me. And you’re asking me to do something when you’ve been missing every time I, I needed you. There’s no way I’m going to believe you in a moment when there’s an alternative narrative that I can follow. And I think that we need to take a lot more seriously the work of demonstrating what we do and why we do it. In the moments where there aren’t crises and we’re not asking people to take a leap of ultimately faith in us. And the second part of it is we need to take more seriously the way that people think about us. One of the things I learned when I ran for office was that the most important skill in politics is understanding how you’re perceived. How do people understand you? What are they seeing out of you, when you talk what do they hear? When you walk in what do they see? Right. And I think we have a real self-perception problem in public health. We think that people are going to give us the benefit of the doubt because we’re the good guys and we’re trying to do good work and we’re severely underpaid. And don’t you know, I could have. And that doesn’t matter if we’re serious about being taken seriously. We had to have shown up in the moments when we didn’t want we didn’t have to ask. And I think that that’s that’s the space where you actually can build a trusting relationship. When when people are afraid, you’re like, hey, you know me, I’ve been around here. Remember when you we talked about this other thing? Well, here’s here’s what I’m asking from you now and here’s why. Right. And look at how the other thing built out and how it worked out. Uh. I think we are at 7:43 and I know there are other questions. Um. And I also know that we got to move on to a big a big party. And so I don’t want to keep folks from the party. Um. I I Jane, thank you so much for allowing us to sort of see ourselves from the outside in. And uh the perspective that you gave us.

 

Jane Coaston: You’re all doing great. I just want to, this minute you’re all doing great. You all look shiny and moisturized. You’re all doing great. 

 

Dr. Abdul El-Sayed: Um. Jane, thank you so much for taking the time. 

 

Jane Coaston: Absolutely. Thank you so much for having me. [applause] [music break]

 

Dr. Abdul El-Sayed, narrating: That’s it for today. Thanks to everyone who joined us in Boston. America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra, Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Sandy Girard, Michael Martinez, and me Dr. Abdul El-Sayed, your host. Thanks for listening. This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health.